D R A F T

STATE OF THE SCHOOL

RESULTS OF THE

UNIVERSITY OF COLORADO SCHOOL OF MEDICINE

FACULTY SURVEY

April 23, 2002

INTRODUCTION

In September 2001 the LCME Accreditation Steering Committee and the Dean’s Office (Office of Faculty Affairs) conducted a comprehensive survey of the School of Medicine (SOM) faculty. The objective of the survey was to measure faculty attitudes and opinions in six domains:

1. Career satisfaction and quality of life (including “connectedness” to the missions of the School of Medicine and intent to leave);

2. Programs for faculty development, training and mentorship;

3. Research and scholarship (strength of programs, institutional support);

4. Teaching environment (resources, support and institutional recognition);

5. Clinical Excellence (resources, quality of programs, institutional recognition); and

6. Faculty participation in institutional governance and decision-making.

The faculty survey was web-based and anonymous. It consisted of 75 questions (including demographic variables), and faculty were encouraged to enter comments at the end of each section. The target population included all regular SOM faculty holding the rank of Instructor or above, whether employed by the University of Colorado or by one of the four affiliated hospitals. The survey was conducted over a three-week period. Email announcements were used to notify faculty of the survey and to encourage participation.

Of the 1,431 faculty members eligible to participate, we received completed surveys from 561 (39 percent). Compared to the roster of eligible faculty, Instructors were under-represented in the survey. Women were slightly over-represented (40 percent of respondents, compared to 36% among eligible faculty). The distributions of faculty according to place of employment (University vs. affiliated hospital) and departments (basic science or clinical) were similar among survey respondents and the faculty-at-large.

The results of the survey are presented in the following pages, organized according to the six domains: Career satisfaction and quality-of-life; faculty development; research and scholarship; teaching environment; clinical programs; and participation in institutional governance (Appendix A). In each section the survey results are presented as proportions. “Don’t know” responses were considered to be missing and were excluded from the analysis.

To assess the internal reliability of the survey instrument, summary scores were computed for each domain by assigning a numeric score to each response category (1=strongly disagree, 2=disagree, 3=agree and 4=strongly agree). Then, Cronbach’s alpha was calculated for the questions in each domain. The Cronbach’s alpha scores were in a highly acceptable range (0.70-0.87) for all domains except research/scholarship (alpha=0.55). The Cronbach’s alpha scores are listed in Appendix A.

In each section of the “Results,” we also provide a listing of representative positive and negative comments. Comments were selected to represent the range of ideas, criticisms and suggestions of the faculty. More specific comments (for example, “Assigned mentors don’t work; one needs a variety of mentors who are successful in various areas” and “In primary care fields, excellent patient care and teaching is our job and should be more than enough for promotion”) were more likely to be cited in this report; very general comments (“The research enterprise is dysfunctional” or “I love this place”) were deemed less useful and were less likely to be included.

In several sections, bivariate analyses were conducted; that is, responses were compared according to gender, faculty rank, faculty type (clinician-teacher vs. basic scientist), department type (basic science vs. clinical) or institution (University vs. affiliate). For these analyses, responses were collapsed into two levels: Agree or strongly agree (labeled “Agree”) versus Disagree or strongly disagree (labeled “Disagree”). The chi square test was used to measure statistical significance.

Several limitations should be kept in mind:

· First, the survey was voluntary, and the response rate was only 39%. The attitudes of survey participants may differ significantly from those of the faculty-at-large. Because we used no faculty identifiers, we cannot measure the magnitude or direction of any non-response bias.

· Second, while the overall sample size (561) permitted us to analyze the main responses with adequate precision, in most cases, subgroup analyses and detailed comparisons (for example, according to department or division) were not possible because of small sample sizes.

· Third, in many instances, faculty found the questions too detailed; respondents often chose not to answer certain questions, fearing a loss of anonymity.

· Finally, while the survey questions were pilot-tested among faculty and were revised to improve clarity and face validity, the questions have not undergone rigorous testing for validity.

Despite these limitations, this survey represents the first attempt by the Office of Faculty Affairs to measure the attitudes and opinions of the faculty. The survey provides important information about the range of opinions and attitudes held by current faculty. The survey indicates that faculty share a strong commitment to the SOM, while also sharing certain frustrations. The open survey responses and the comments also include important suggestions for program improvement. To paraphrase Charles Dickens, the University of Colorado School of Medicine is, at once, in the best and worst of times. It has succeeded on many fronts, while it still faces unprecedented challenges.

We hope the results of this survey are helpful in stimulating discussion, opening new avenues for communication and guiding improvements in the programs of the School of Medicine. In a sense, this report represents the “State of the School,” from the faculty’s point of view.

Please address all comments and questions to Steven R. Lowenstein, M.D., M.P.H, Associate Dean for Faculty Affairs. Thank you for your participation.

SURVEY RESULTS

I. CHARACTERISTICS OF RESPONDENTS

Demographic Profile

Of the 542 faculty members who responded to the demographic questions, 324 (60%) were men, and 218 (40%) were women. Most (93%) were white; small minorities were Asian/Pacific Islander (4%), African-American (4%), Native American (<1%) or “Other” (<1%). Only 4% of respondents to the survey stated they were of "Spanish or Hispanic origin.”

Faculty ranks and affiliations

As shown in the graph below, faculty at all ranks were well represented in the survey:

The majority of faculty (87%) listed their appointments as full-time (1.0 FTE); 9% were .50-.99 FTE, and 3% were less than .5 FTE.

Fifty-two percent of faculty had earned M.D. degrees, 29% had Ph.D. degrees, 16% had Masters degrees, and 4% listed their degrees as D.O., D.V.M., J.D., Ed.D., Sc.D. or “other.”

Comment:

One faculty member expressed disappointment that a particular “terminal degree” (M.S.W.) was not recognized or “considered to count for promotion at UCHSC.”

The majority of faculty respondents were employed by the University of Colorado. Eighty-one percent of respondents were University employees (vs. 84 percent in the SOM faculty-at-large). In the chart below, the category “Other” was used primarily by faculty reporting “split” appointments.

Five hundred forty-nine faculty members reported their primary appointment in the School of Medicine. Of these, 94 (17%) had primary appointments in basic sciences departments, as outlined in the chart below:

The majority of faculty respondents (455, or 83%) reported primary appointments in clinical departments. As shown below, participation in the survey varied widely among the clinical departments:

Separate questions also asked faculty about membership in various SOM programs and centers (for example, the Cancer Center, the Webb-Waring Institute, the Center for Human Nutrition, the Molecular Biology Program, the Program in Health Care Ethics, Humanities and Law and the Center on Aging).

Academic Profile

Faculty members were asked to describe their roles and assignments at the University of Colorado School of Medicine, using such terms as “researcher,” “clinician,” “clinician-teacher,” etc. Although many respondents used the “comments” section to describe overlapping, or other, job assignments, the majority of respondents chose one of the main categories.

Interestingly, the largest group of faculty respondents (33%) selected the “triple threat” category of clinician-teacher-researcher.

The largest group of faculty (one-third of the total) reported they were clinician-teacher-researchers, or “triple threats.”

II. CAREER SATISFACTION AND QUALITY OF LIFE

A. It is easy to balance family responsibilities with career development at the UC-SOM:

B. I have enough time for leisure activities, rest and vacation:

The responses to these two questions indicate that the majority of faculty finds that academic careers are demanding and that it is often difficult to balance the responsibilities of academic and family life. Just 40 percent report they have enough time for rest or vacation. Unfortunately, there are few published studies or other benchmarks that might enable us to compare our results with results from other medical schools or other medical career settings.

C. My career has been progressing at a satisfactory rate since I joined the UC-SOM:

D. During the past year I have seriously considered leaving academic medicine:

E. Overall, I am optimistic about my professional future at the UC-SOM:

43% of faculty have considered leaving academic medicine in the past year.

Most members of the faculty (70%) report satisfactory career progress. Also, the majority of faculty are optimistic about their future at the SOM (64%) and are not considering leaving academic medicine (57%). At the same time, more than one-third of faculty members (36%) are not optimistic, and 43% of faculty responding to the survey have considered leaving academic medicine in the past year.

Summary of Comments

The following comments appeared most frequently and may indicate the principal reasons that faculty members report personal stress, difficulty balancing family and academic life and intent to leave (The numbers in parentheses indicate the number of times that this comment, or a similar comment, appeared in the responses):

· Marginal income, when compared to colleagues in industry or private practice (N=41);

· Grant pressure, salary insecurity and dependence on soft money (N=17);

· Multiple, unreasonable teaching, research, administrative and clinical expectations; not enough academic time (N= “too numerous to count”):

· Teaching, research, spending time with students and residents are all activities that must be crammed into the few hours that are left at the end of a busy week. What’s the point?

· Too much emphasis on clinical earnings, as opposed to academic careers. Now it’s just a job, not an academic career…soon there will be no enthusiastic clinicians left.

· Jack of all trades, master of none … the increasing clinical workload leads to inadequate time for excellence in teaching or anything else.

Teaching, research, spending time with students and residents are all activities that must be crammed into the few hours that are left at the end of a busy week. What’s the point?

· Paperwork, bureaucracy, administrative aggravations, charting demands, UPI and PEOPLESOFT (N=52):

· The regulatory environment impedes ability to conduct research; now, it is easier to conduct research in the private practice or industry setting;

· It is especially [bad] with respect to COMIRB and paper work for grants through affiliated institutions

· JCAHO and HCFA have micromanaged us to a ridiculous level, putting useless paperwork ahead of patient care…but I don’t think beuarocracy is worse here than anywhere else;

· Everything has gotten worse with PEOPLESOFT…there is very little institutional support for research administration … rules and administrative systems (hiring, COMIRB, PEOPLESOFT, GCRC) have become a real drag on efficiency, enthusiasm and progress.

· The paperwork is not overwhelming – [but] it is regularly irritating.

· UPI is incredibly inefficient – still reviewing billing charts from a year ago. There are major problems with relationships with referring providers. UPI bankrolls tens of millions and does nothing to improve our lot.

The regulatory environment impedes our ability to conduct research; now, it is easier to conduct research in the private practice or industry setting

· Lack of state, Regental and institutional support, and lack of philanthropy, for higher education and advanced research (N=19)

· This is a root problem that places a tremendous load on the faculty to perform all their functions as academics and clinicians on a cash-and-carry basis.

· This is a harsh environment – Institutional support for all activities of academic medicine is lacking;

· People succeed by their own will, with little support from the state or the institution.

· The administration’s main role is to act as a barrier to grants, contracts and inventions. The hospital doesn’t give a hoot about teaching or research – unless it makes money.

The paperwork is not overwhelming – [but] it is regularly irritating

· Fitzsimons (N=39)

The sacrifice, expense and inconvenience of the move [to fitzsimons] are in the long-term interests of the public and the institution…but many of the faculty just complain…where is their sense of vision and the common good?

· Fitzsimons is a costly center that it is draining the life out of everything else.

· Bricks and mortar are now the order of the day, with failure of the Master Plan (version 5.6) to provide credible financing for the SOM site.

· This project may be in the long term best interests of the people and the UCHSC, but it is a step backwards for us now. It won’t benefit me during my tenure here. So much thought, energy and finances placed on the future leaves the present teaching and research needs neglected.

· The Fitzsimons move is an example of absence of any joint governance. Whether it’s the research building or educational space, or any other component of the master plan, delegates of the administration walk in and tell faculty what has happened. The term “Master Plan” is an apt one; all the decisions are “done deals” by the masters.

So much thought, energy and finances placed on the future [of fitzsimons] leaves the present teaching and research needs neglected.

· Fitzsimons is a wonderful opportunity, but many of the faculty just complain rather than help facilitate the move. Where is their sense of vision and common good?

· The tremendous sacrifice, expense and inconvenience of the move [to Fitzsimons] are in the long-term interest of the public and the institution; what I am disgruntled by is the ubiquity of arrogance among the highest rank[s] of institutional leaders”

The term “Master Plan” is an apt one; all the decisions are “done deals” by the masters

Despite these areas of concern, frustration and disappointment, the survey data indicate that the majority of faculty remain engaged, optimistic and committed to their careers, to academic medicine and to the University of Colorado School of Medicine.

Although there were numerous comments regarding non-competitive salaries, very few respondents mentioned other aspects of compensation. There were two requests for domestic partner benefits. There were also several specific comments about the need for more liberal vacation benefits. Representative comments include:

· “Vacation is inadequate and should increase with seniority;”

· “It is obvious that income in academic medicine will never approach private practice, but vacation time should.”

Vacation is inadequate and should increase with seniority

III. FACULTY DEVELOPMENT

A. I have had adequate mentoring as a faculty member at the UC-SOM:

B. I understand the criteria by which I will be judged for promotion or tenure:

C. My department has an effective program of faculty development:

D. My department chair (or Division Head) has evaluated my academic progress regularly and provided constructive criticism and feedback:

My junior colleagues have no idea what to do to be promoted and see the world as a place to just do ‘one more case.’

E. Faculty time spent in the delivery of clinical services is appropriately recognized in the evaluation and promotion process.

Clinical service is grossly under-recognized and under-rewarded…you will not be able to retain junior faculty if you do not reward them for the considerable clinical work that they do.

A.

In recruiting faculty, my department has been effective in identifying qualified women and under-represented minorities

Representative Comments

Inadequate recognition of clinical service

· Job assignments are inconsistent with promotion requirements

· My junior colleagues have no idea what to do to be promoted and see the world as a place to just do ‘one more case.’

· Promotion is based heavily on academic achievements, giving inadequate weight to clinical achievements—thus, we have lost many excellent clinicians over the past 4 years.

· Clinical service is grossly under-recognized, under-appreciated, under-rewarded and undervalued…There is no incentive to excel in clinical work.

· The only criteria for any real recognition appear to be grant funding or publications. Clinical work is not rewarded nearly as much as research productivity in the medical school.

· You will not be able to retain junior faculty if you do not adequately reward them from the considerable clinical work that they do.

Junior faculty are often used as workhorses to keep the educational and clinical activities of the institutions running

Inadequate recognition of teaching

· Teaching is beginning to be rewarded, but there is still an emphasis on judging promotion and prestige based only on research.

· Some value is given to teaching in terms of promotion, and clinical activities are given some credit --- but clearly, the primary value of the medical school is research.

· Teaching, clinical work and administration are all discounted in the promotion review….[In fact] the more one contributes to teaching, the department or the campus, the less one’s chances of being promoted.

· Publication is still the number one thing, superceding service in teaching and patient care.

Mentoring and career development

· It is very difficult to begin research projects.

· I was told one day to ‘find a mentor;’ That was the entire discussion, and no assistance was offered.

· SOM administration does not pay adequate attention to junior faculty and their needs for career development; often, junior faculty are used as workhorses to keep the educational and clinical activities of the institutions running.

· As a senior faculty member, it is difficult to mentor junior faculty, given limited resources and time…[and often] mentors have no track record or training to be mentors.

· I have to use mentors out of state.

· As junior faculty, we are all on our own, and we know it. This is not a very friendly or nurturing environment in which to work.

· Assigned mentors don’t work ---I have chosen to seek advice from many faculty who are successful in one area or another. Opportunities to find mentors exist if you have initiative

· Despite regular meetings regarding my academic progress, feedback has been vague, to say the least, and not helpful …in delineating specific objectives to enhance my career.

· Mentoring program at this institution is weak, with certain departments being exceptions. My department has improved greatly in mentoring functions.

· I have not had a formal evaluation in 4 years.

· Haven’t had an academic meeting with my either of my chairmen in my 13 years at UCHSC.

· My department still struggles with insufficient time for career development. I am evaluated every year, but my department chairman doesn’t really understand what I do.

· “It is easy to underestimate how much time, energy and resources will be needed to recruit, mentor and develop faculty, especially physicians, of a diverse nature.”

· I have never had a mentor and yet am supposed to mentor other assistant professors, (which I do not have the time or expertise to do).

· The UC-SOM and Denver Health have been wonderful to me. I was well-mentored and had every opportunity a faculty member could want.

Assigned mentors don’t work. You have to seek advice from many faculty who are successful in one area or another. Opportunities to find mentors exist, if you have the initiative.

Promotion requirements and standards

· I understand the promotion criteria by which I should be judged, but I don’t think that holds much relationship to the criteria by which I will be judged.

· All anyone cares about is if you have a grant, especially an R01.

· Too little value is placed on teaching and clinical service.

· There is a lack of flexibility in the promotion process to account for different working environments and differences in opportunities to teach.

· In primary care [fields], excellent patient care and teaching should be more than enough to promote---it’s our job!

· Clinical care is undervalued ... one problem is how to evaluate it. Does anyone have any idea how excellence in clinical service is recognized?

· General internists and other generalists are viewed as dispensable, are paid consistently less and can barely get recognition---yet we perform the majority of clinical care and teaching and mentoring of our students and residents.

does anyone have any idea how clinical excellence is recognized and rewarded?

· Delivering clinical service is a barrier to promotion; indeed, neglecting clinical care is rewarded.

· “Who knows how promotions work? The process is shrouded in secrecy.”

· “As long as basic scientists judge our promotion, clinical excellence will be a meaningless mission of the university.”

· “The single most important criterion for promotion is grant money…that’s the way I understand the “criteria.”

The school of medicine and Denver Health have been wonderful to me. I was well mentored and had every opportunity a faculty member could want.

Who knows how promotions work? The process is shrouded in secrecy. I understand the promotion criteria by which I should be judged…but how will i be judged?

· “My department and the SOM value revenue to the exclusion of academic pursuits.”

Status of women and under-represented minorities

· Female faculty experience isolation, lack of advancement or inadequate salary, support, mentors

· Our division does not have a friendly environment toward women scientists.

· Salaries for women are still below those of their male peers.

· There is a clear bias against women, with insurmountable barriers to advancement.” In our department, many women have left in recent years.

· My department has been successful in recruiting women, but ineffective in promoting and retaining women.”

· Our department has a national reputation for not being supportive of women and minorities.”

· Overall, the SOM could be much more creative in supporting faculty, especially women, who are struggling to balance academic careers and parenting.

· Recruiting of women – yes; minorities – no. I don’t see many efforts to recruit/retain qualified ethnic minority faculty.

· Minorities are hard to find, but we keep trying.

· The Dean has not been supportive in our recruitment of minorities in terms of helping with competitive start-up packages.

It’s easy to underestimate how much time, energy and resources will be needed to recruit, mentor and develop faculty…especially physicians

There is a lack of flexibility in theh promotion process to account for different working environments and differences in oportunities to teach.

In primary care fields, excellent patient care and teaching should be more than enough to promote---it’s our job!

Other comments

· There needs to be a more defined research track; research faculty are treated as second-class citizens; they are designated faculty but not recognized as such.

· Tenure is no longer meaningful. I would support removing tenure or establishing a second non-tenure track.

· No opportunities for Instructors or Masters-trained faculty to advance (Mentioned frequently by faculty in the CMHIP/Circle Program); my department head does not associate with Instructors, who are not even allowed to attend faculty meetings.

· The UC-SOM needs to recognize the talents and contributions of its instructors and senior instructors and provide more avenues for recognition and advancement.

· Nurse practitioners have a subordinate role in terms of academic or clinical acknowledgment, though our patient satisfaction numbers rise exponentially

· There are no opportunities for pure research scientists to advance

The survey data and open comments, summarized in the above sections, suggest that, to many faculty members, clinical practice and billing pressures have crowded out all their opportunities to teach and engage in scholarship. There is not enough time for academic work, given the ascendancy of clinical obligations. There is a general sense that neither clinical service nor teaching is rewarded adequately in the promotion process, and that the promotion process is probably not flexible enough to account for diverse job requirements. Some faculty report that mentoring is inadequate, while others comment that mentors are available and that a variety of mentors is sometimes needed.

IV. Research and Scholarship

A. I have enough time for scholarly pursuits

B. At the UC-SOM there are state-of-the-art facilities, resources and programs to support faculty in their role as scholars.

Representative